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Health Skills II Unit 201

Health Skills II Unit 201. Immobility. Immobility. Definition incapable of movement may involve a specific part of the body due to injury may involve lower part of body (paraplegia) may involve one side of body (hemiplegia) or may involve entire body from the neck down (quadriplegia).

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Health Skills II Unit 201

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  1. Health Skills IIUnit 201 Immobility

  2. Immobility • Definition • incapable of movement • may involve a specific part of the body due to injury • may involve lower part of body (paraplegia) • may involve one side of body (hemiplegia) • or may involve entire body from the neck down (quadriplegia)

  3. Causes of Immobility • Physical • Environmental • Neurological • Psychological/Social • Medication

  4. Causes of Immobility • Physical examples: • a bone fracture • a surgical procedure • a major sprain or strain • cancer • the aging process

  5. Causes of Immobility • Environmental examples: • side rails on a bed • restraints on bed or chair

  6. Causes of Immobility • Neurological examples: • brain damage due to trauma or illness • stroke • cerebral palsy • spinal injuries Brain

  7. Causes of Immobility • Psychological/Social examples: • stress • decreased motivation • hospitalization, long term care facility residents • a lifestyle that is sedentary created by a voluntary or involuntary action

  8. Causes of Immobility • Medication examples: • those that induce a comatose state • sedatives • narcotics

  9. Effects of Immobility • theloss of the force of gravity acting on our body in an upright positiondue to immobility greatly affects our natural body functions

  10. Effects of ImmobilityMusculoskeletal System • decrease in tonus • the resting tension in a muscle that determines tonicity or firmness • atrophy • a decrease in the size of a muscle. Muscles lose strength, endurance and mass very quickly when inactive

  11. Effects of ImmobilityMusculoskeletal System • demineralization • bone is a living tissue and requires muscle activity and weight bearing to provide for the formation of new bone growth • immobility results in a loss of calcium in the bones due to lack of activity and weight bearing. • this can lead to osteoporosis and possible spontaneous fractures.

  12. Effects of ImmobilityMusculoskeletal System • plantar flexion of ankle (foot drop) • caused by improper positioning of the foot or resulting from a heavy blanket on the foot putting excessive weight or stretching at the ankle joint • lose the ability to move the ankle into dorsiflexion

  13. Effects of ImmobilityMusculoskeletal System • contracture • is a permanent shortening/tightening of a muscle due to prolonged immobility • fibrous tissue replaces muscle cells that eventually waste away, weaken and lose flexibility • contractures can cause a loss of function

  14. Effects of ImmobilityMusculoskeletal System • ankylosis • a fixation or fusion of a joint due to abnormal stretching/shortening of a muscle

  15. Effects of ImmobilityCardiovascular System • normal muscle activity squeezes veins & returns blood to the heart

  16. Effects of ImmobilityCardiovascular System • the immobilized body initially pools blood in the trunk of the body causing : • increased workloadto the cardiovascular system • increased heart rate • increased stroke volume

  17. Effects of ImmobilityCardiovascular System • prolongedinactivity causes sluggish circulation & pooling of blood in the veins of lower extremities

  18. Effects of ImmobilityCardiovascular System • phlebitis • is an inflammation of a vein. This frequently is the result of immobilization

  19. Effects of ImmobilityCardiovascular System Inside view of arteries • thrombus • a blood clot that originates at the site of obstruction • embolism • a blood clot that dislodged from a site of origin & moved within the system until it became “stuck”, causing an obstruction Fatty streak Plaque build-up Thrombus Total occlusion formation complication Embolus Thrombus

  20. Effects of ImmobilityCardiovascular System • orthostatic hypotension • a drop in systolic blood pressure of 20 mmHg upon moving to an upright position (sitting or standing) • dizziness, fainting, pale, sweating, fast heart beat

  21. Effects of ImmobilityRespiratory System • initially: • when a person is immobilized, the bodies metabolism decreases • unless there is an infection • this results in a decreased demand for oxygen • the respirations will be slow and shallow

  22. Effects of ImmobilityRespiratory System • prolonged immobility causes: • decrease in oxygen & increase in carbon dioxide in the blood due to poor gas exchanges • an inability to deep breathe & cough adequately results in respiratory secretions pooling in the lungs • this may lead to respiratory infections (hypostatic pneumonia)

  23. Effects of ImmobilityRespiratory System • prolonged immobility causes: • atelectasis • collapsed small air sacs within the lungs that are responsible for providing oxygen to the blood and removing the carbon dioxide from the blood. • atelectasis results in obstructions of the smaller airways • increased respiratory rate

  24. Effects of ImmobilityIntegumentary System (Skin) • skin breaks down easily when circulation is impaired and new cells can’t regenerate

  25. Effects of ImmobilityIntegumentary System (Skin) • common effect of immobility and skin breakdown is a pressure ulcer • this isdue to the compression of the body soft tissue and/or bony prominence compressed between mattress or adaptive devices

  26. Effects of ImmobilityIntegumentary System (Skin) • pressure ulcers begin with reddish areas and may develop into large open and deep wounds • Graphic: www.hamill.law.com

  27. Effects of ImmobilityIntegumentary System (Skin) • conditions that put patients at risk for pressure ulcers include: • paralysis • due to inability for spontaneous movement and inability to recognize pressure when taking place • medications • may alter the ability for movement or recognition of pressure points

  28. Effects of ImmobilityIntegumentary System (Skin) • cont. • restraints • the inability for spontaneous movement and the restraint may be the cause of pressure points • obesity • more heat and moisture are created and this can lead to quick skin break down • this patient may be less active and create more friction when they do move

  29. Effects of ImmobilityIntegumentary System (Skin) • cont. • emaciated/malnourished • with little tissue over the bony prominences, the areas are at risk for pressure ulcers developing • patients incontinent of feces and/or urine • will create a site of bacteria accumulation that will create skin break down

  30. Effects of ImmobilityIntegumentary System (Skin) • cont. • improperly positioned patients are at risk when support devices have not been used or improperly placed • NOTE: injury to skin is minimized by frequent position changes, massage and proper support device placement

  31. Effects of ImmobilityUrinary System • positioning patients in a supine position leads to residual urine in the calyces of the kidneys • impeding the urine’s normal flow of gravity to the bladder

  32. Effects of ImmobilityUrinary System • the supine position also causes residual urine to accumulate in the bladder, as it is difficult to empty the bladder from this position

  33. Effects of ImmobilityUrinary System • stasis of urine leads to: • infections of the urinary system • the development of stones within the urinary system • bladder distention and incontinence of urine

  34. Effects of ImmobilityGastrointestinal (GI) System • immobility decreases the muscle activity in the GI system • leads to constipation and impaction of stool • weak muscles make it difficult to eliminate stool from the supine position into a bedpan

  35. Effects of ImmobilityGastrointestinal (GI) System • appetite is often reduced when immobilized, creating nutritional deficiencies that may lead to fatigue and depression

  36. Effects of ImmobilityPsychosocial Aspects • becoming immobile drastically changes a persons life • whether sudden or gradual onset, the response varies per individual

  37. Effects of ImmobilityPsychosocial Aspects • mental attitude & motivation suffer & the patient may experience: • exaggerated emotional responses • disorientation • feelings of dependency • inability to sleep well • fear

  38. Can You Imagine • not being able to take care of yourself? • the anxiety over what is to happen next? • the frustration over loss of independence?

  39. Preventive Measures to Effects of Immobility • educate the patient & family on how to prevent the effects of immobility by being active • encourage patient & family to be involved with care & activities of daily living • provide range of motion exercises according to the PT or MD’s orders • provide regular position changes

  40. Devices Used for Immobilized Patients • Purpose of devices: • to provide comfort • reduce pressure areas • used to maintain proper alignment • definition of alignment is placing or maintaining of body structures in their proper anatomical positions

  41. Normal Alignment • spine and extremities are in a true anatomical position • spine is straight • shoulders & hips are level with each other and parallel to the sides of bed • toes pointed forward

  42. Devices Used to Reduce Effects of Immobility • pillows • provide support • elevate body parts to promote return venous blood flow to the heart • bed boards • provide support • aids in good body alignment

  43. Devices Used to Reduce Effects of Immobility • adjustable bed • allow for changes in position • decrease pressure of affected areas • assist in getting patient in & out of bed • examples of specialty beds • Rotorest, Kinair, Ciroelectric & Stryker • foot board • assists in maintaining correct foot position and in preventing plantar flexion

  44. Devices Used to Reduce Effects of Immobility • cradle • used to lift blanket off body • side rails of bed • provide safety • trapeze • allow the patient to assist in positioning changes and other activities

  45. Devices Used to Reduce Effects of Immobility • blanket rolls or foot splints • used to support proper lower extremity alignment by preventing external (lateral) rotation • forearm pan splint or hand cones • minimize contracture of the hand(s) and provide proper wrist alignment

  46. Indications for Foot & Hand Splints • splinting will be necessary to prevent complications of long term immobilization for patients who will have a lengthy immobilization &who are unableto voluntarily reposition their self

  47. Indications for Foot & Hand Splints • when there is a loss of dorsiflexion the patient may need a foot splint • the ankle must be able to achieve a 90 degree angle in order to have balance, transfer and walk 90 degree angle between foot & lower extremity

  48. Indications for Foot & Hand Splints • when evidence of external rotation of hip is present, use foot splints or trochanter rolls to maintain a neutral position to avoid muscle tightening Splint prevents rotation of hip

  49. Indications for Foot & Hand Splints • when evidence that wrist drop is developing, provide forearm splints for prevention • when evidence that hand contractures are developing, provide a hand cone for prevention Wrist splint prevents wrist drop & contractures of the hand

  50. Restraints • definition • physical restraint • any manual method or physical or mechanical device, material, or equipment attached or adjacent to the patient’s body that cannot be removed easily by the patient that restricts freedom of movement or normal access to one’s self

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